Spoiler Alert - if you haven't seen the movie 127 Hours, and have no idea what happened to Aaron Ralston, and didn't read his bestseller "Between A Rock And A Hard Place", and still somehow care about seeing the flick for the shocking ending, go watch it now before proceeding.
A few months ago, my family and I watched the movie 127 Hours. It is the story of Aron Ralston's fight to survive after getting trapped in a slot canyon, alone and beyond help. In the end, he cuts off his arm below the elbow to get free and then hikes out. At the edge of his endurance, dehydrated and weak, he spots, on the trail ahead of him, hikers who may be his salvation. He tries to yell to get their attention. All that comes out is a croak. At this point I, very uncharacteristically, went to pieces.
I had been getting more and more tense as I saw him move in slow motion (relative to a dive accident) through the phases of survival. However it was the croaking and its link to my own IPE accident in June 2010 that really struck home. Wracked by sobs, I was overwhelmed by the dread I felt in the face of death by drowning, the guilt I felt about passing my son to a friend when I could no longer be his buddy, and the relief that I was alive. Later, I was able to talk to my wife for the first time about the experience. Not the events (this happened, then this happened, and so on) but the battle that raged between my ears as I fought for survival. I'll do my best to describe that process here.
Image via WikipediaBut let me start with something practical. The very best advice I have ever received from any diver, I got from famed explorer Richie Kohler. He was discussing the dangers of deep wreck diving and shared this thought which I have passed along to folks as "Kohler's Rule": When facing an incident underwater, be it entrapment, a bad reg, zero viz or whatever, Richie advises to stave off panic by checking two things. 1. Am I still breathing? (if not, you are in seriously deep shit), 2. Can I grab my ass? (If not you may be mired in deep shit). It's brilliantly simple. What Ritchie was trying to point out is that most if not all problems are solvable if you have time and mobility. Free flowing reg? Still breathable? Still have mobility? Great! Then work the problem!
Kohler's Rule is both funny and profound but, most importantly, it is very memorable! Please pass it along, with attribution to the divers you know. It saved my life (thanks Richie).
Ok, so back to the accident.
In June of 2010, I experienced Immersion Pulmonary Edema during a dive off the North Carolina coast. Coughing started at 50' and became wore and worse culminating in near-respiratory arrest after reaching the boat. While rare, IPE is a terrifying condition because one leaks fluid from their blood stream into the lungs without aspirating any seawater. You drown from within.
When I had the first cough at 50 fsw, I thought nothing of it. I didn't commonly cough underwater but, apart from the odd, metallic taste, it didn't raise any concern. (Stage 1: DENIAL)
But the second cough sure as Heck did! Followed quickly by a third! (Stage 2: RECOGNITION)
At 30 fsw I was coughing continuously. Already my diaphram was struggling to pull breaths in between the spasms.
Stage 3: ASSESSMENT: My mind moved into a sort of triage:
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A few months ago, my family and I watched the movie 127 Hours. It is the story of Aron Ralston's fight to survive after getting trapped in a slot canyon, alone and beyond help. In the end, he cuts off his arm below the elbow to get free and then hikes out. At the edge of his endurance, dehydrated and weak, he spots, on the trail ahead of him, hikers who may be his salvation. He tries to yell to get their attention. All that comes out is a croak. At this point I, very uncharacteristically, went to pieces.
I had been getting more and more tense as I saw him move in slow motion (relative to a dive accident) through the phases of survival. However it was the croaking and its link to my own IPE accident in June 2010 that really struck home. Wracked by sobs, I was overwhelmed by the dread I felt in the face of death by drowning, the guilt I felt about passing my son to a friend when I could no longer be his buddy, and the relief that I was alive. Later, I was able to talk to my wife for the first time about the experience. Not the events (this happened, then this happened, and so on) but the battle that raged between my ears as I fought for survival. I'll do my best to describe that process here.
Image via WikipediaBut let me start with something practical. The very best advice I have ever received from any diver, I got from famed explorer Richie Kohler. He was discussing the dangers of deep wreck diving and shared this thought which I have passed along to folks as "Kohler's Rule": When facing an incident underwater, be it entrapment, a bad reg, zero viz or whatever, Richie advises to stave off panic by checking two things. 1. Am I still breathing? (if not, you are in seriously deep shit), 2. Can I grab my ass? (If not you may be mired in deep shit). It's brilliantly simple. What Ritchie was trying to point out is that most if not all problems are solvable if you have time and mobility. Free flowing reg? Still breathable? Still have mobility? Great! Then work the problem! Kohler's Rule is both funny and profound but, most importantly, it is very memorable! Please pass it along, with attribution to the divers you know. It saved my life (thanks Richie).
Ok, so back to the accident.
In June of 2010, I experienced Immersion Pulmonary Edema during a dive off the North Carolina coast. Coughing started at 50' and became wore and worse culminating in near-respiratory arrest after reaching the boat. While rare, IPE is a terrifying condition because one leaks fluid from their blood stream into the lungs without aspirating any seawater. You drown from within.
When I had the first cough at 50 fsw, I thought nothing of it. I didn't commonly cough underwater but, apart from the odd, metallic taste, it didn't raise any concern. (Stage 1: DENIAL)
But the second cough sure as Heck did! Followed quickly by a third! (Stage 2: RECOGNITION)
At 30 fsw I was coughing continuously. Already my diaphram was struggling to pull breaths in between the spasms.
Stage 3: ASSESSMENT: My mind moved into a sort of triage:
- OK on Kohler's Rule? Check! But check back in a few minutes.
- Depth? Now 30'.
- Noah (my son) OK? Ascending normally. Check!
- Lots of air? Check!
- Cause of cough? No idea (tingling of panic).
- Apply Kohler's Rule. Check!
Stage 4: PLANNING: Though wracked with coughs, my training was kicking in. I knew I was in trouble and I knew I needed a plan for the next few minutes. Here's what I came up with:
- Goal: Get Noah and I safely out of the water.
- Ascend normally to the hang line.
- Complete 3 minute stop
- If unable to complete stop, hand Noah off to Tim (who was on the line already)
- If symptoms unresolved, surface immediately behind the boat, inflate BC and declare an emergency.
I probably could have taken Noah straight to Tim and surfaced. I could have surfaced immediately, etc. But the important thing for me was that I had a plan, any plan. By working the plan, I was able to balance things a little: on the negative side, your symptoms are getting worse and you're over-breathing your reg, but on the plus side, you're on the hang line and 1 minute into your safety stop - almost home! Yay!
By the timeI was on the hang line, I was still trying to sort through the possible causes as I started to hyperventilate. I was really over-breathing my reg but I could not stop. It was reflexive. Everything I tried to slow my breathing failed. What was weird was how my brain interpreted this. Part of my brain sent a very clear message: IT'S THE REG!!! SPIT THE REG OUT!! It was insane! I have never before had the feeling of two brains in one head but the argument that raged was intense and fighting the urge to do something fatally stupid was a tremendous strain. (Apply Kohler's Rule: Breathing? Ass? Ok, then, work the plan.)
Stage 5: ACCEPTANCE: About 2 minutes into the stop, it became clear that I was going into respiratory arrest. If I stayed, I would die and likely take Noah with me. I put Noah's hand in Tim's and signaled them to buddy up. Hoping beyond hope that they understood (neither was aware of what was happening for me), I ascended.
Stage 6: NEAR-PANIC: Surfacing was very strange. Thus far, I had kept panic at bay, moving calmly through my normal routine and plan. As I approached the surface, I revised the plan to include a big arm wave to get attention. But when I reached the surface, panic hit me like a freight train. Every fiber of my being wanted to be on that boat. The only thing I can compare it to is the feeling I had after first jumping out of a plane into free fall. That momentary sensation that each of my cells are trying to get back into the plane (which, since it is not trailing flames and smoke, seems a much safer place to be) threatening to break loose if necessary.
I clawed at the swim step and croaked, "Can't Breathe! Can't Breathe!!" Turning to Dave on the ladder, I croaked, "Get the F*@K off!!" and was hauled bodily from the water by the Diver Down's excellent crew. Now on board, I expected to feel relief as I coughed up whatever was causing the issue. Instead, I collapsed and felt a wave of horror at the realization that whatever was wrong was probably going to kill me.
I was physically and mentally exhausted, in respiratory arrest (or near to) and hypoxic. Lacking oxygen, my brain began to shut down.I became calm, accepting death as a less horrible alternative than my current reality. What kept me going was the support and encouragement of my buddies. Noah at my head, Roy wrapped around my body saying, "It's Ok. We got you buddy! Stay with us." Sharky in my face imploring me to breathe in the offered oxygen. Even a little bit. There was for me a point where my will failed. I survived on the will of the people around me. Noah gave me an immediate, tangible reason to live. Roy pushed the pain and panic back. Sharky, eyes unblinking inches from my face, had a line directly into my brain. He said "breathe", I breathed. He said "come on, give me another, brother", I strained for another breath, and so on. For two hours as we raced back to shore.
Thankfully, I survived. It is so hard to capture the emotions of the day and very hard to imagine that most of it happened in just a few minutes stretched to an eternity by suffering. I hope some of this makes sense, that Kohler's Rule sticks with you as it has with me, and that the telling in some small way prepares you to be a better buddy or, if you are so unfortunate, to be a more successful victim. If there's a final lesson, I feel it would be this: In an accident, your presence of mind and careful action, be it underwater or on the surface, be you victim or rescuer, could be the difference between life and death.
Safe Diving,
Phil
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